The 2012 Peers Helping Peers: Innovations in Tobacco Dependence Education and Intervention Project brought together consumers of mental health services and mental health specialists to address high rates of smoking within their mental health agencies. The project provided a 1-day training for 26 people including mental health consumers, peer specialists, certified tobacco treatment specialists, social workers, and nurses. They used the Consumers Helping Others Improve their Condition by Ending Smoking (CHOICES) model to address tobacco use within mental health agencies in New Jersey and Pennsylvania.

According to Patricia Dooley, Director of the CHOICES program, smoking rates are much higher among consumers of mental health services compared to the general public. Ms. Dooley states that approximately 20% of the general population of the United States are smokers, while somewhere between 50 and 70 percent of consumers of mental health services are smokers. Furthermore, consumers of mental health services die nearly 25 years earlier than the average U.S. citizen.

Most general hospitals have no-smoking policies; however, psychiatric hospitals are less likely to have such regulations.

The CHOICES program is a peer-based model in which mental health patients who are nonsmokers or who have recently quit smoking are trained on delivering a 45-minute presentation on the CHOICES model. The purpose of the presentation is to disseminate information on the health risks of smoking and to encourage one-on-one consultations between the presenter and other mental health patients. The consultations are an opportunity to develop individualized plans to begin to address smoking.

Attendees also receive a brief training in motivational interviewing by Dr. Marc Steinberg, Ph.D., a faculty member at the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School. The CHOICES advocates deliver the model using motivational interviewing.

The CHOICES program encourages the implementation of policies to reduce tobacco use among mental health patients and the promotion of health care system changes including strategies to increase access to smoking cessation services and treatments.

After receiving the 1-day training, attendees may tailor the CHOICES model to their mental health agencies. They present the material in both mental health agency educational forums and group discussions.

Peers within mental health agencies are developing surveys to assess rates of smoking within agencies and to gauge interest in quitting. One peer is now working within his mental health agency to establish a plan to address nicotine dependence as part of an ongoing treatment plan. Another peer is working with his board to create a tobacco- free policy at the agency.

The 1-day training with both peers and mental health specialists helped to:

• Expand the program to include all levels of mental health providers;
• Increase the awareness among health care agencies of the high rates of smoking and its associated health risks; and
• Gain the support of health care agency staff in developing ways to help consumers of mental health services to quit tobacco use.

Ms. Dooley concluded, "By training this number of individuals, the dissemination of information could impact hundreds, if not thousands, for those who implement the skills they have learned."

Peers Helping Peers: Innovations in Tobacco Dependence Education and Intervention